Guidelines and Ceiling Rates for Permission/Reimbursement for Bariatric Surgery Procedures under CGHS/CS(MA) Rules

The Ministry of Health & Family Welfare issued guidelines for Bariatric Surgery procedure along with ceiling rates under CGHS and CS(MA) Rules, 1944.

Bariatric Surgery procedures shall be allowed in respect of CGHS/CS(MA) beneficiaries/parients with ‘morbid obesity’ as per the guidelines. Under the guidelines,

i) Laparoscopic Gastric Banding Surgery;

ii) Laparoscopic Sleeve Gastrectomy;

iii) Laparoscopic Gastric Bypass and

iv) other cases –

as per examination and recommendation of an Expert Committee, are allowed

Hospitals/Centres approved for Bariatric Surgery are Government Hospitals, Hospitals run by PSUs, Private hospitals empanelled under CGHS/ CS(MA) Rules. However, Bariatric Surgery shall not be allowed in private non empanelled hospitals under CGHS/ CS(MA) Rules.

Bariatric Surgery procedures are planned/elective procedures and hence, not regarded as emergency procedures. Prior permission has to be obtained from the competent authority on the basis of recommendation given by a Government Specialist before the surgery is undertaken. No ex-post facto approval for reimbursement shall be given. For those Bariatric Surgery procedures requests for prior permission in such cases shall be examined by an Expert Committee on a case to case basis and in consultation with IFD.

The ceiling/package rate for all Bariatric Surgery procedures as per the guidelines, shall be – Rs. 2,25,000 (Rupees Two Lakh Twenty Five Thousand Only) or actuals, whichever is lower, for Semi- Private Ward eligibility. The package rate is to be increased by 15 per cent in case of private ward eligibility and reduced by 10 per cent in case of general ward eligibility.

(Ministry of Health & Family Welfare, Department of Health & Family Welfare, File No.S.11030/33/13/CGHS(P), dated November 06, 2013)